BACKGROUND: Optic neuritis (ON) in childhood is thought to be more likely bilateral and less likely to lead to multiple sclerosis (MS) vs ON in adults. METHODS: The authors evaluated clinical features, maximal visual deficit and recovery, visual evoked potentials (VEPs), neuroimaging, and outcome in a cohort of children with ON. RESULTS: Records of 36 children (female/male ratio 1.6), ages 2.2 to 17.8 (mean 12.2) years, were reviewed. ON was unilateral in 58% and bilateral in 42%. Maximal visual deficit was severe in 69%, but full recovery occurred in 39 of 47 affected eyes (83%). VEPs were abnormal in 88%. Neurologic abnormalities in addition to those associated with ON were documented in 13 children. Neuroimaging studies of the optic nerve were abnormal in 55%. Brain MRI in 35 children demonstrated white matter lesions separate from the optic nerves in 54%. Follow-up is 2.4 years (0.3 to 8.3 years). To date, 13 children (36%) have been diagnosed with MS and 1 has Devic disease. Bilateral ON was more likely to be associated with MS outcome (p = 0.03). All 13 children with MS had white matter lesions on brain MRI. None of the children with a normal brain MRI have developed MS to date. CONCLUSIONS: Contrary to expectations, optic neuritis (ON) in childhood was more likely to be unilateral, multiple sclerosis (MS) risk was high (36% at 2 years), and bilateral rather than unilateral ON was associated with a greater likelihood of MS. Clinical findings extrinsic to the visual system on baseline examination (p < 0.0001) and MRI evidence of white matter lesions outside the optic nerves (p < 0.0001) were strongly correlated with MS outcome.
BACKGROUND:Optic neuritis (ON) in childhood is thought to be more likely bilateral and less likely to lead to multiple sclerosis (MS) vs ON in adults. METHODS: The authors evaluated clinical features, maximal visual deficit and recovery, visual evoked potentials (VEPs), neuroimaging, and outcome in a cohort of children with ON. RESULTS: Records of 36 children (female/male ratio 1.6), ages 2.2 to 17.8 (mean 12.2) years, were reviewed. ON was unilateral in 58% and bilateral in 42%. Maximal visual deficit was severe in 69%, but full recovery occurred in 39 of 47 affected eyes (83%). VEPs were abnormal in 88%. Neurologic abnormalities in addition to those associated with ON were documented in 13 children. Neuroimaging studies of the optic nerve were abnormal in 55%. Brain MRI in 35 children demonstrated white matter lesions separate from the optic nerves in 54%. Follow-up is 2.4 years (0.3 to 8.3 years). To date, 13 children (36%) have been diagnosed with MS and 1 has Devic disease. Bilateral ON was more likely to be associated with MS outcome (p = 0.03). All 13 children with MS had white matter lesions on brain MRI. None of the children with a normal brain MRI have developed MS to date. CONCLUSIONS: Contrary to expectations, optic neuritis (ON) in childhood was more likely to be unilateral, multiple sclerosis (MS) risk was high (36% at 2 years), and bilateral rather than unilateral ON was associated with a greater likelihood of MS. Clinical findings extrinsic to the visual system on baseline examination (p < 0.0001) and MRI evidence of white matter lesions outside the optic nerves (p < 0.0001) were strongly correlated with MS outcome.
Authors: Grazyna Adamus; Lori Brown; Shayne Andrew; Roberto Meza-Romero; Gregory G Burrows; Arthur A Vandenbark Journal: Invest Ophthalmol Vis Sci Date: 2012-01-25 Impact factor: 4.799
Authors: Amy T Waldman; Mark P Gorman; Mary R Rensel; Tracy E Austin; Deborah P Hertz; Nancy L Kuntz Journal: J Child Neurol Date: 2011-04-25 Impact factor: 1.987
Authors: Stacy L Pineles; Grant T Liu; Amy T Waldman; Elizabeth Lazar; Mark J Kupersmith; Michael X Repka Journal: J Neuroophthalmol Date: 2016-06 Impact factor: 3.042
Authors: C E Al-Haddad; M G Sebaaly; R N Tutunji; C J Mehanna; S R Saaybi; A M Khamis; R G Hourani Journal: AJNR Am J Neuroradiol Date: 2017-12-07 Impact factor: 3.825